David A. Mahns

Impairment of human proprioception by high-frequency cutaneous vibration

These experiments assessed whether the impairment in proprioceptive acuity in the hand during ‘interfering’ cutaneous stimulation could be caused by inputs from Pacinian corpuscles. The ability to detect passive movements at the proximal interphalangeal joint of the index finger was measured when vibrotactile stimuli were applied to the adjacent middle finger and thenar eminence at frequencies and amplitudes that favour activation of rapidly adapting cutaneous afferents. Inputs from Pacinian corpuscles are favoured with high‐frequency vibration (300 Hz), while those from Meissner corpuscles are favoured by lower frequencies (30 Hz). Detection of movement was significantly impaired when 300 Hz (20 μm peak‐to‐peak amplitude) complex vibration or 300 Hz (50 μm) sinusoidal vibration was applied to the middle finger and thenar eminence. In contrast, detection of movements was not altered by low‐frequency sinusoidal vibration at 30 Hz with an amplitude of 50 μm or with a larger amplitude matched in subjective intensity to the 300 Hz sinusoidal stimulus. Thus it is unlikely that the impairment in detection was due to attention being diverted by vibration of an adjacent digit. In addition, an increase in amplitude of 300 Hz vibration led to a greater impairment of movement detection, so that the impairment was graded with the input. The time taken to nominate the direction of applied movement also increased during 300 Hz but not during 30 Hz sinusoidal vibration. These findings suggest that stimuli which preferentially activate Pacinian, but not Meissner corpuscles, impair proprioceptive acuity in a movement detection task.

Allodynia mediated by C‐tactile afferents in human hairy skin

Non‐technical summary  What triggers a realignment of sensations, e.g. a stimulus that is perceived as non‐painful in intact skin, but evokes pain in sunburned skin, is yet to be ascertained. This phenomenon is clinically termed allodynia. We show that gentle tactile stimulation (vibration and brushing) of the hairy skin can exacerbate the underlying muscle pain (allodynia) evoked by infusion of hypertonic saline into the tibialis anterior muscle. This effect is dependent upon a low‐threshold, mechanosensitive class of nerve fibres in the hairy skin known as C‐tactile (CT) fibres. Knowledge of the role of CT fibres in allodynia increases our understanding of the mechanisms that underlie sensory‐perceptual abnormalities – a common manifestation of clinical‐pain states and neurological disorders.

Mechanosensory perception : are there contributions from bone-associated receptors

1. The identity of the receptors and afferent nerve fibres that mediate the sense of touch varies somewhat with body location. Those that have been most intensively characterized are associated with the distal glabrous skin of the limbs and, in primates, mediate the sense of touch in the fingertips and palms. In this glabrous skin region, there appear to be three or four principal classes of tactile sensory nerves that fall into two broad groups. One group, the so‐called slowly adapting (SA) receptors and afferent fibres, is responsive to static mechanical displacement of skin tissues and is made up of two classes, the type I (SAI) fibres that innervate Merkel receptors and the type II (SAII) fibres that innervate Ruffini endings. The second broad group displays a pure dynamic sensitivity to tactile stimuli and also falls into two principal classes, the rapidly adapting (RA) tactile fibres that are associated with Meissner corpuscle receptors and the Pacinian corpuscle (PC)‐associated class of tactile afferent fibres.

Absence of large-diameter sensory fibres in a nerve to the cat humerus

A fine branch of the median nerve innervates the periosteum and medullary cavity of the cat humerus. After branching to innervate the periosteum on the medial surface of the humerus, the nerve enters and supplies the medullary cavity via a nutrient foramen, accompanied by a small artery and vein. The composition of the fibres in the nerve was examined using electron microscopy. Myelinated fibres with diameters of 0.8–6.6 µm and unmyelinated fibres with diameters of 0.1–1.4 µm were observed. These diameters indicate that afferent fibres of this nerve are confined within the Group III and IV categories, and may therefore be nociceptive or mechanoreceptive in function. In addition, autonomic efferent fibres may also be present in these fibre groups. As no fibre diameters greater than 7 µm were noted, it appears that Group I and II fibres are absent in this nerve. The fibre distribution suggests that the principal role of this nerve is to relay bone‐related nociceptive or mechanoreceptive information to the central nervous system and to provide autonomic regulatory influences on the bone.

Nerve repair: toward a sutureless approach

Peripheral nerve repair for complete section injuries employ reconstructive techniques that invariably require sutures in their application. Sutures are unable to seal the nerve, thus incapable of preventing leakage of important intraneural fluids from the regenerating nerve. Furthermore, sutures are technically demanding to apply for direct repairs and often induce detrimental scarring that impedes healing and functional recovery. To overcome these limitations, biocompatible and biodegradable glues have been used to seal and repair peripheral nerves. Although creating a sufficient seal, they can lack flexibility and present infection risks or cytotoxicity. Other adhesive biomaterials have recently emerged into practice that are usually based on proteins such as albumin and collagen or polysaccharides like chitosan. These adhesives form their union to nerve tissue by either photothermal (tissue welding) or photochemical (tissue bonding) activation with laser light. These biomaterial adhesives offer significant advantages over sutures, such as their capacity to unite and seal the epineurium, ease of application, reduced invasiveness and add the potential for drug delivery in situ to facilitate regeneration. This paper reviews a number of different peripheral nerve repair (or reconstructive) techniques currently used clinically and in experimental procedures for nerve injuries with or without tissue deficit.

Long term recovery of median nerve repair using laser-activated chitosan adhesive films

Sutures remain the standard peripheral nerve repair technique, whether applied directly or indirectly to nerve tissue. Unfortunately, significant postoperative complications can result, such as inflammation, neuroma formation and foreign body reactions. Photochemical-tissue-bonding (PTB) using rose Bengal (RB) integrated into a chitosan bioadhesive is an alternative nerve repair device that removes the need for sutures. Rats were arranged into three groups: RB-chitosan adhesives-repair, end-to-end epineural suture-repair (surgical standard) and sham laser-irradiated control. Groups were compared through histological assessment, electrophysiological recordings and grip motor strength. RB-chitosan adhesive repaired nerves displayed comparable results when compared to the standard suture-repair based on histological and electrophysiological findings. Functionally, RB-chitosan adhesive was associated with a quicker and more pronounced recovery of grip force when compared to the suture-repair.

Cav3.2-expressing low-threshold C fibres in human hairy skin contribute to cold allodynia--a non-TRPV1- and non-TRPM8-dependent phenomenon.

Abstract It is generally agreed that cold allodynia is a consequence of impaired (A&dgr;-fibre-mediated) central inhibition of C-nociceptive inputs. However, it is also known that C polymodal nociceptors are not activated at innocuous low temperatures. Recently, we demonstrated the contribution of C-tactile fibres to tactile allodynia. In this study, we investigated whether this, or a related, C-fibre class contributes to cold allodynia. In 30 healthy and 3 chronic pain subjects, a series of normally innocuous localised thermal stimuli were applied to the skin overlying a painful tibialis anterior muscle (induced by infusion of hypertonic saline). The effects of thermal stimulation on muscle pain were observed before and after compression blockade of myelinated fibres. Furthermore, intradermal capsaicin, menthol and TTA-A2 were used for desensitisation of TRPV1, TRPM8, and T-type calcium (Cav3.2) channels, respectively. Before muscle pain, all thermal stimuli were reported as nonpainful regardless of whether myelinated fibres were conducting or not. During muscle pain, dynamic skin cooling (32°C → 20°C) evoked significant and reproducible increases in the overall pain intensity (allodynia). This increase was short lived and locked to the dynamic phase of cooling with pain levels returning to baseline during sustained cooling. Dynamic warming (32°C → 39°C) had no effect on pain levels. Cold allodynia persisted after nerve compression and TRPV1 and TRPM8 desensitisation but was abolished by localised Cav3.2 blockade. In clinical subjects, C-fibre-mediated allodynia was observed without the need for experimental pain-producing manipulations. In conclusion, cold allodynia represents a non-TRPV1- and non-TRPM8-dependent phenomenon, which is mediated by low-threshold Cav3.2-expressing C fibres.

An intact peripheral nerve preparation for monitoring the activity of single, periosteal afferent nerve fibres

A preparation is described in which it is possible to selectively activate and monitor the activity of the individual periosteal afferent nerve fibres arising from the humerus bone of the cat. The nerve is a fine branch of the median nerve that accompanies the small artery and vein that enter the nutrient foramen of the humerus. By freeing this fine nerve from nearby tissue over a length of approximately 1-2 cm and placing it over a silver hook recording electrode, it becomes possible to identify and monitor electrophysiologically, the impulse activity of individual periosteal afferent fibres activated by focal mechanical stimulation of the periosteum. With this preparation it will be possible to examine the central actions and security of transmission at central synaptic targets for single, small-diameter afferent fibres arising from bone.

In vitro cell compatibility study of rose bengal–chitosan adhesives

Photochemical tissue bonding (PTB) using rose bengal (RB) in conjunction with light is an alternative technique to repair tissue without suturing. It was recently demonstrated that laser‐irradiated chitosan films, incorporating RB, bonded firmly to calf intestine in vitro. It is thus required to investigate the possible cytotoxic effects of the RB–chitosan adhesive on cells before testing its application to in vivo models.

Tissue repair strength using chitosan adhesives with different physical-chemical characteristics

A range of chitosan-based biomaterials have recently been used to perform sutureless, laser-activated tissue repair. Laser-activation has the advantage of bonding to tissue through a non-contact, aseptic mechanism. Chitosan adhesive films have also been shown to adhere to sheep intestine strongly without any chemical modification to chitosan. In this study, we continue to investigate chitosan adhesive films and explore the impact on the tissue repair strength and tensile strength characteristics of four types of adhesive film based on chitosan with different molecular weight and degree of deacetylation. Results showed that adhesives based on chitosan with medium molecular weight achieved the highest bonding strength, tensile strength and E-modulus when compared to the other adhesives.